Social anxiety and paranoid beliefs in adolescents

Background Paranoid beliefs are common in the general adolescent population. The paranoia hierarchy suggests common social evaluative concerns may develop into persecutory thoughts via ideas of reference, a milder intermediary facet of paranoia. Socially anxious concerns and paranoid beliefs co-occur in adolescent and adult groups, but the specifics of their association is not well understood. In a general population adolescent sample, we examined (a) whether social anxiety and paranoia can be differentiated, (b) patterns of co-occurrence and (c) psychosocial factors that differentiate social anxiety alone versus in combination with paranoia.

Methods An online cross-sectional survey design, recruiting UK adolescents (n = 604, 14–17 years), via Qualtrics. Participants were quota sampled for equal distribution on age and gender.

Results Measurement models supported a hierarchical structure, with separate but correlated general factors of paranoia and social anxiety. This model was invariant across age groups 14–15 and 16–17 years. The largest subgroup of participants with clinically significant symptoms showed elevated social anxiety plus paranoia (21%, n = 124), followed by high social anxiety without paranoia (14%, n = 84). Paranoia without social anxiety occurred the least (7% n = 39). Subgroup comparisons suggested social anxiety plus paranoia was characterised by exposure to threating experiences (discrimination, bullying, adverse life events in the last 12-month), anxious attachment and high levels of distress, whereas social anxiety was more associated with feeling inferior to others, enhanced loneliness, avoidant attachment and a low sense of belonging.

Conclusions Social anxiety and paranoia are differentiable in adolescents. Paranoia commonly co-occurs with social anxiety, especially in those with exposure to threat environments in the last 12-month. Adolescents with social anxiety plus paranoia reported the highest levels of distress, underscoring the importance of improved understanding of this group.